September 6, 2006

This makes no sense at all. The man is so fat he's immobilized, which means someone has to be procuring the food for him. He weighs 550 kilos -- 1200+ pounds. It ordinarily takes 12 calories to maintain each pound of weight. He's sedentary, to say the least, so it's less than than 14,544 calories we get from the standard calculation, but still a tremendous amount. Who is feeding him a week's worth of food every day, day after day? What would motivate anyone to do something that is so expensive, so much work, so destructive, and so strange?

IN THE COMMENTS: Pogo tells a vivid story:

I have taken care of a few men like this. One weighed in at over 700 pounds. He was also immobile, and admitted to hospital for a number of related concerns, but they had to cut out the side of his house to get him out (no longer fitting through the door) and transported in a delivery truck (he needed a hoist and didn't fit in an ambulance).

His wife and mother brought him food at home and, despite orders to the contrary, as an inpatient. He would whine and plead like a three year old for food; all guilt and manipulation.

New Year's Eve, 3 months into the stay, he begged to have "just a few pieces of shrimp" to celebrate (exceeding his then 5-to-600 cal diet). I came in the room at midnight to see him holding a huge tray from Red Lobster up to his face, using his arm to shovel the food as fast as possible into his mouth, not even chewing, like in a pie-eating contest.

After we took it away from him, he threatened to kill himself (his frequent ploy to gain sympathy, one that worked on many many caregivers). I was so angry I yelled, "Go ahead. But tell me, how are you going to do it?" I opened up the window. "You can't move, except your arms. You can't walk to this window and jump. You can't even fit through the opening. Frankly, aside from choking on food, I can't even imagine how you'd commit suicide. So be my guest; let us know what you figure out."

His mom started it, it seems. His wife learned to continue the family ritual of feeding him, even long after he quit moving from his bed. I can't explain it, I'm afraid. Some people just can't behave as mature adults, but remain children forever, with appetities insatiable, like Prader Willi syndrome without retardation. C.S. Lewis explains it better than Freud, I think.

I have taken care of a few men like this. One weighed in at over 700 pounds. He was also immobile, and admitted to hospital for a number of related concerns, but they had to cut out the side of his house to get him out (no longer fitting through the door) and transported in a delivery truck (he needed a hoist and didn't fit in an ambulance).

His wife and mother brought him food at home and, despite orders to the contrary, as an inpatient. He would whine and plead like a three year old for food; all guilt and manipulation.

New Year's Eve, 3 months into the stay, he begged to have "just a few pieces of shrimp" to celebrate (exceeding his then 5-to-600 cal diet). I came in the room at midnight to see him holding a huge tray from Red Lobster up to his face, using his arm to shovel the food as fast as possible into his mouth, not even chewing, like in a pie-eating contest.

After we took it away from him, he threatened to kill himself (his frequent ploy to gain sympathy, one that worked on many many caregivers). I was so angry I yelled, "Go ahead. But tell me, how are you going to do it?" I opened up the window. "You can't move, except your arms. You can't walk to this window and jump. You can't even fit through the opening. Frankly, aside from choking on food, I can't even imagine how you'd commit suicide. So be my guest; let us know what you figure out."

His mom started it, it seems. His wife learned to continue the family ritual of feeding him, even long after he quit moving from his bed. I can't explain it, I'm afraid. Some people just can't behave as mature adults, but remain children forever, with appetities insatiable, like Prader Willi syndrome without retardation. C.S. Lewis explains it better than Freud, I think.

I saw a Dr. Phil with some dangerously obese people on once (yes I'm admitting to having watched Dr. Phil) and they were basically able to just bully their families into bringing them food all day long, go to the store for donuts when they had cravings, etc.

(Remember the 600+ pound woman who had fused to her couch a few yearts back? Same situation... she had a live-in boyfriend who just shovelled it in.)

Madison Man:Experienced that twice ina way. Once at a freezing Army/ Navy game. It was great the lady was huge so she blocked the freezing wind from hitting me. And the next time was at a 100 degree day at Camden Yards- not so good, it was like sitting next to an oven and he seemed to suck all the oxygen and air out of our section.

That question was the strong point of What's Eating Gilbert Grape? I haven't seen the movie, but the book did a great job of presenting family dynamics where everybody kept on feeding Mom even though they knew it was killing her.

I have watched a couple of shows on the Discovery Health Channel about a couple of morbidly obese people. I think oe show was titled "The Half-Tonne Man' or something like that. What I noticed as a casual observer is this - the people had the genes that made them fat( other family members were obese too), plus they were guilty of being manipulative,and whiny, and using t hose skills to eat limitlessly. And both the shows I saw had the fatsos behave exactly in the manner Pogo described in his/her comments.

I wonder what his favorite food is, or if the compulsion is so strong that he has no favorite? I wonder how many pounds of food he can consume at one lying? We have a mild fascination with the grotesque. I wonder if the family sells tickets to the more affluent to come view him? Let's say a $3.00 entry fee and $4.00 if you want to ask him a few questions. They must have sufficient means, somehow, to feed an appetite equal to that of 5 people.

Along those lines Goesh, I can't help but wonder at what point did the fat man realize that he can't even get up to use the bathroom and think, "I am now sitting in my own feces. Well, I guess that's not so bad." That to me would be the tipping point. When you prefer eating more food to being able to not sit in your own crap, that's the point that you don't want to get to.

Okay, that right there. What the hell is that? How can there be a woman who has so little self-respect that she would stay with a man who weighs 700 pounds and does not leave his bed? I can't even begin to understand how someone could twist their mind up such that staying was better than going.

Well...thinking about it, I can. It's guilt-avoidance. If she left him, she'd feel guilty about leaving, and she doesn't want to feel guilty. This type of behavior has led to more misery than anything else, and it's ridiculous. People are told over and over that they "shouldn't be selfish". As a result, doing anything that is solely intended for our own happiness feels wrong. But we don't avoid these behaviors because we've carefully considered all the options and decided that it's best to avoid them--we avoid them because if we did do those things, we'd feel guilty. So, in the end, it's still all about us--except that it's "about us" in a way that we've been taught is acceptable, i.e. "not doing something wrong". And so everyone's unhappy, but at least we don't feel guilty!

WARNING: involves math and metabolism, FEEL FREE TO SKIP. Just a point of information, the amount of food necessary to maintain an obese body weight is much less then that the 30 kcal/kg that it takes to maintain lean body weight. When we calculate caloric requirements for a patient in the hospital we base it on ideal body weight + only 10-20% of excess body weight no matter how obese they are. E.g. a 5'8" 70 kg (ideal body weight) male would get ~2100kcal, a 5'8" 100 kg male would get 2280 kcal (2100 +20% of 30kg X 30kcal/kg) and a 5'8" 300 kg male would get ~2690-3480 kcal (2100 + 10-20% of his excess body weight X30kcal/kg) not 3000kcal and 9000kcal respectively. This is not a reducing diet, it's just that fat does not have a high metabolic demand.

I'm glad Jeremy brought that up, I didn't want to. Ewwww! After eating 10 lbs of pickled bolgna with jalepenos washed down with a 6 pack of beer, one can only imagine the disgusting horror this fellow would enact on the entire neighborhood. My god! Such an image makes necrophilia the lesser evil.

Couple comments, first only part of gastric bypass surgery reduces food intake, the other part reduces caloric intake from what little food is eaten by removing a portion of the intestines from the digestive tract. This radically reduces the amount of food eaten, and the amount of calories that can be absorbed by that food. It also affects the way the body feels about the drastic cut in food being eaten, to some degree.

Secondly, paraplegics can't move either and thus their bathroom needs have solutions different from our own as well.

Pogo-The only other take-away I can find from that is perhaps morbidly obese folks anticipate the coming day when they'll no longer be able to access the bathroom and so preemptively engage the alternative solutions.